My introduction to indigenous health in central Australia from the
early '90s was, and in many ways still is, a shock about the
white-black divide. Having spent most of my community development life
working with my own people in Ghana (Tsey 2008) I found myself trying to
practice as an outsider in Indigenous Australia, an entirely different
socio-economic environment involving the world's oldest surviving
culture. The question that dominated my mind was how to make sense of
the stark contradictions between wealthy democratic Australia on the one
hand, and small minority Indigenous populations living in relative
poverty and deprivation with issues of alcohol and other substance abuse
and inter-personal violence so endemic and public on the other hand
(Boffa, George and Tsey 1994). As an outsider 'where to start'
in the context of such social volatility was and still is clearly a
challenge for me (Tsey 1994a; b; c; d; Tsey 1997).

As a group, Indigenous Australians experience higher levels of
illness and premature death compared with the rest of the population.
Alcohol abuse in particular has a disproportionately high negative
impact on Indigenous communities in Australia, at both the individual
and community levels, in terms of its contribution to premature
mortality, chronic illness, social disruption and economic costs
(Ministerial Council on Drugs Strategy 2003; Australian Institute of
Health and Welfare 2005). Concerns dating back to late 1980s regarding
an apparent enthusiasm for descriptions of this excess mortality and
morbidity in the research literature, rather than effective
interventions (National Aboriginal Health Strategy Working Party 1989)
were empirically shown in a 2006 critical review which highlighted a
dearth of intervention research in Australian communities compared with
Canada and New Zealand (Sanson-Fisher et al 2006). In other words, in
Australia, we are good at describing the nature and extent of Indigenous
health problems but we are not so good at investing in interventions
that work.

In July 2007, the Australian Federal Government under the Liberal
Party Prime Minister John Howard, took an unprecedented move to announce
a wide range of national emergency measures in the Indigenous
communities of the Northern Territory of Australia designed to curb
excessive levels of alcohol and other substance abuse and associated
inter-personal violence, including child sexual abuse (Commonwealth of
Australia 2007). Some of the key elements of the intervention included:

* bans on alcohol and pornography materials;

* increased policing and law enforcement;

* welfare reforms making receipt of state welfare payments
contingent on parental responsibility, including school attendance;

* compulsory acquisition of Indigenous land aimed at providing
incentives for private investors, including estate developers; and

* compulsory health checks for children.

Although the objectives of the intervention are widely recognised
as a necessary and important development in Indigenous affairs, the
process has also attracted extensive criticism as evident by thematic
analysis of the Weekend Australian coverage of the radical new reforms
since July 2007(Bridge, Whiteside and Tsey, unpublished data). According
to the influential Indigenous thinker and reformer, Noel Pearson, whose
ideas about indigenous substance abuse to which I return later
influenced the government decisions in the first place, the focus on
alcohol and policing is important, but there must also be a strategy for
building Indigenous social and cultural ownership (Pearson 2007). A
number of commentators have also condemned the top-down approach that
was taken by the Federal Government and the way in which the legislation
underpinning the intervention was prepared in great haste with little
community consultation or Indigenous input (Havnen 2007).

Australia saw a change in Government in November 2007 and with it
another change in policy in Indigenous affairs. Kevin Rudd's first
parliamentary week as Labour Party Prime Minister was enshrined with a
national apology, intended to be an act of contrition for past injustice
(see below) towards indigenous people and a new beginning, and in this
first week he invited the Opposition Leader, Brendon Nelson, to be part
of a bipartisan 'war cabinet' for Indigenous affairs. Rudd has
defined ambitious new benchmarks for Indigenous progress, for example
every Indigenous Australian four year old will attend an early childhood
centre within five years; the gap in literacy will be halved within a
decade; job outcomes will be improved; mortality rates will be reduced
and; within a decade, the gap in life expectancy will be closed. The new
government says that evidence-based policy will guide the achievement of
these goals (Kelly 2008; Bridge, Whiteside and Tsey, unpublished data).

The fact that both the July 2007 intervention and the subsequent
national apology and bipartisan "war-cabinet" constitute
promising new beginnings in Indigenous affairs cannot be overstated.
Unfortunately, I fear that the potential to achieve meaningful and
lasting change, including the new government's bold and welcomed
performance targets is at risk of being jeopardized by an unproductive
dichotomy or binary positioning that continues to characterize attitudes
towards the national indigenous policy reform agenda(Bridge, Whiteside
and Tsey, unpublished data). For example, on the one hand, there is a
tendency for those who support the original interventions to be totally
dismissive of all policies, programs and services in Indigenous
communities prior to July 2007 as "failed". What is more,
supporters of the intervention and radical reform label the critics,
especially those working in Indigenous affairs, as members of a
"failed Indigenous service industry" who are committed to
protecting their professional interests, including jobs at all costs
(See, for example, Rinoult 2008). On the other hand, there is a tendency
by critics to dismiss the intervention as mere arrogance, top down and a
lack of recognition for the hard work that those working at the coal
face have been doing for years in often difficult circumstances,
including inadequate government funding. This leaves little room to
reflect on the day to day efforts by Indigenous people themselves to
improve their health and wellbeing and how new radical national
initiatives can enable rather than undermine such efforts. Clearly, the
question is not whether one position is more valid than the other. Each
position, on their own, tells only half the story. The real challenge is
how to move beyond the binary positioning and find new creative
opportunities for radical government macro interventions to interface
more productively with proven existing community-based services and
programs so as to empower and enable people to take greater charge of
their own situation.

This paper, the second in a 2-part series (Tsey 2008), presents an
evaluation case study of an indigenous family empowerment program. The
aim is to use detailed documented experiences of the program
participants to effect change in the context of huge structural
constraints as an opportunity to go beyond the current binary positions
by showing ways in which existing bottom up empowerment initiatives can
interface more effectively with top down national intervention efforts.
Such collaborative approaches are needed urgently in order to create the
types of synergy required to rebuild Indigenous social norms(Pearson
2001; Cape York Institute of Leadership 2006), akin to principled autonomy (Gaughwin 2008), identified as key to tackling substance abuse
in Indigenous Australia.

Family Wellbeing empowerment program

The Family Wellbeing (FWB) empowerment program was developed by a
group of Adelaidebased indigenous people who were affected by the stolen
generation policies of Australia, one of the past injustices for which
the new prime minister offered an apology. 'Stolen generation'
refers to the thousands of indigenous Australians that were forcibly removed by the state from their families as children because of their
Indigenous Australian heritage and raised in government institutions and
foster homes between 1910 and 1970. A national survey revealed that four
out of 10 indigenous people aged 15 years or over reported that they or
one of their relatives had been removed from their natural family
(Australian Bureau of Statistics 2002)

The designers of the FWB program felt that not enough was being
done to support Indigenous families to recover/develop the relevant
skills and capacity to appropriately address not only the pain and hurt
of the past, but also the day to day challenges of being a relatively
marginalised minority people in a highly affluent Australian society
occupying their traditional lands. As one architect of FWB explained,
'the question we were asking ourselves is, "How did we
survive?" If we can understand how we survived then we can help
others' (Tsey and Every 2000: 2). Consequently, the group undertook
a series of consultations to learn about the contemporary survival
experiences of Indigenous Australians. The results of the consultations
formed the basis of the FWB program, which was developed by and for
Indigenous Australians. The content also draws heavily on a range of
therapeutic and spiritual traditions, including such as meditation and
visualization, that were considered suitable and appropriate for
Indigenous Australian people's needs, but also adaptable to the
needs of people of different cultural backgrounds, including
nonIndigenous Australians.

FWB started in 1993 through informal community meetings where
people shared day to day experiences and supported each other, building
an awareness of the power that comes from sharing information in safe
and supportive group environments. From here the program developed into
a structured but highly flexible and adaptable learning process. FWB now
has five stages, each consists of 30-40 hours of group learning. Central
to the program is the opportunity to reflect and articulate clear values
or 'qualities' that guide people in making sense of their
lives, including their past pain and dispossession, and their current
social relationships and responsibilities. These values and qualities
underpin a range of topics presented in each of stage of the program.
The first stage examines basic human needs and the kinds of behaviour,
such as substance abuse, that can result when these are not met. Stage 2
deals with the process of change, examining how change affects people
and how it can be experienced as an opportunity to grow and develop
qualities and strengths. Stage 3 focuses on family violence, brings a
value based analysis to the topics of violence and abuse and the skills
for addressing and healing from destructive relationships. Stage 4
reinforces the importance of life balance, values and traditions. The
final Stage 5 provides mainly hands-on practice in enabling people who
have done the previous four stages to themselves become confident and
skilled facilitators of the program.

Since 2001, I have worked as part of multidisciplinary teams
adapting this innovative valuesbased community education program as a
practical tool for researching the role of empowerment and control in
improving health and wellbeing (Tsey et al 2007). The following case
study from Alice Springs in central Australia is presented to highlight
research findings on the impact of the program which are consistent with
those observed across all 10 Indigenous Australian communities and
settings around Australia that have participated in the research up to
the end of 2007.

Study participants and emergent themes

Alice Springs had a reported population of 23,888 in 2006
(Australian Bureau of Statistics 2006). Of this, 18.8 per cent
identified as Indigenous (Aboriginal, Torres Strait Islander or both).
Alice Springs is the major service centre for 260 Central Australian
communities. There are significant disparities in educational status,
employment, individual income and household size between Indigenous and
non-Indigenous residents (Australian Bureau of Statistics 2006).

The Indigenous community of Alice Springs, one of the main targets
of the July 2007 emergency intervention, was one of the first places to
embrace the FWB program. Concerns about substance abuse, violence, child
neglect, youth suicides and other social dysfunction motivated the local
Indigenous organizations to obtain 3 different short term government
grants between 1998 and 2004 to implement the program with the aim of
empowering families to better address these problems. Human service
providers were targeted in the first instance with an expectation that
these people would in turn develop the capacity to deliver the program
to others.

In order to evaluate the impact and sustainability of this program,
a set of in depth interviews were conducted in 2002/03. By that time, a
total of 73 people had participated in the FWB program in the Alice
Springs community and many had become facilitators. Of the 73
participants, 24 were interviewed by the time data saturation was
achieved. All interviewees were Indigenous. Among the 24 interviewees
were the only 3 men who had participated in the program up to that time.
Interviewees' ages ranged from 30 to 52 with a median age of 37.
Although most of the people interviewed (75%) were employed at the time
of the interviews, none of them was in possession of a university
degree. In addition, some interviewees nominated a close family member,
friend or work colleague to be interviewed and a total of 8 such people
were interviewed. FWB participants were invited to describe in narrative
or story forms the priority areas of their lives in which they used the
FWB skills and knowledge, and the opportunities and challenges involved.
The other interviewees were asked to comment on any changes that they
had noticed in the person nominating them. The narratives were then
thematically analysed and the findings presented using 'thick
description' (see Clifford Geertz 1983 cited in Flyvbjerg 2001).
Drafts were presented in workshop settings to participants for
validation as well as to obtain permission for the findings to be
published.

Three interrelated themes relevant to a need for citizen
participation in redefining community values and norms about right and
wrong behaviour as core elements in efforts to tackle Indigenous
substance abuse and social dysfunction, were identified from the data
analysis:

1) Changes in self

2) Greater ability to provide and receive constructive support

3) Challenges and opportunities in maintaining change when the
social environment is resistant to change.

A systems theory perspective maintains that social systems take
shape depending on the ways in which their various members behave and
interact. As individual members of the system act differently, the
nature of the social system changes. This perspective on change was
borne out in the FWB data. As the FWB participants began to approach
life from the perspective of values about right and wrong behaviour,
they experienced what amounts to personal transformation or changes in
self. This in turn had a ripple effect on people around them. A
conceptual framework (Figure 1) describes the intricate links between
(1) the internalisation of values-based norms about right and wrong
behaviour; and (2) the enhanced capacity of the program participants to
promote individual and community health and wellbeing. This conceptual
framework is supported by participants' testimonies recorded
verbatim.

[FIGURE 1 OMITTED]

1. Changes in self

Participants described changes in their values and approaches to
life. Rather than reacting immediately to a situation, or responding in
a habitual way, a number of participants said they had developed the
ability to stop and assess a situation, reflect on what is important and
what is not and then respond.

I examine situations more now rather than jumping off the deep end.
I vapproach things in different ways now--body language, tone, and
the way I speak. Sometimes if your blood was boiling then you'd
jump in but now I think things through first. I'm not approaching
issues with aggression now.

This resulted in participants becoming more aware of and how to
meet their needs.

Doing FWB has taught me skills that enabled me to realise that I
need to meet my own needs. I need to look after myself rather than
looking after everyone else.... I wanted to stop feeling like I was
a victim. I wanted to stop taking on board other people's problems
when it wasn't my problem. I wanted to be more assertive, not to be
demanding. I wanted a good home life. I was depressed sometimes.
Now when this happens I can examine what's making me feel like that.
I needed to learn to look after myself.

They identified the creation of personal boundaries with regard to
right and wrong behaviour as one of the most liberating changes they
experienced as a result of participating in the FWB program:

The biggest thing in our community is saying 'no' to
family.

I've always been a person to give up my home for people. Over the
years I've given up a lot. Friends take advantage of you, they use
you. I'm the sort of person who thinks if you go and stay with
people you pull your weight. Now when I have people there I tell
them not to use my stuff. I used to let people even though this
would make me angry.

Participants stories' were full of remarks such as 'I
liked who I changed into' and 'it made me a better
person'. Improved self-esteem and self-confidence illustrate the
development of compelling new personal narratives and clearly show the
value of values effectiveness of valuesbased empowerment education.

I considered myself illiterate. I was pretty insecure. Once I did
FWB I had more than I believed I had. Then I went to college and studied
counseling. I had to write assignments. I hadn't been to school
since I was 14.

Just waking up and being free. I don't have to answer to anyone.
I've got a car, I've got money in my purse. I can buy what I want.
In the past I had to buy a carton of beer and meat because of my
partner. If I went on a field trip for work I had to buy beer, meat,
smokes and leave him $50.

This latter person is no longer in this relationship. Another
person said that her attitude towards having a partner changed as she
realized 'you don't have to be married to be happy'.

2. Ability to give and receive constructive support

Social connectedness is acknowledged to be an important determinant
of health. Relationships give people support, happiness, contentment and
a sense they belong and have a role to play in society. Where people
lack social connection they are more likely to experience lower levels
of wellbeing and they are at increased risk of physical and mental
disability and chronic disease (World Health Organization, 2003). One of
the enduring effects of the FWB program is the friendship and support
networks that program participants developed based on common values and
norms about right and wrong behaviour:

I enjoyed being with those women every Friday. Sometimes you could
feel very drained but I always felt like a whole load had been
lifted off my shoulders afterwards. We had a good group ... I made
some good friends out of FWB.
It's opened a circle of friends for (her). A circle of friends who
have gone through the same type of experiences. Close family member
commenting.

As a result, they showed greater ability to support their children:

It's helped me with my kids. Realising that they're people and
they have feelings too. They need to be listened to too. Before I
was stressed out with home life and family-them turning up wanting
food and money. Then you've got food and bills and that. You'd
get home and say to the kids 'Go away' because you'd never have
time. Now I put things aside and forget about myself and my worries
and give them more time. I'm starting to find out what their needs
are because I've slowed down.
My family comes and talks to me about things. My sons, they drink
and I talk to them. I help them understand things like drugs and
alcohol.
The kids are happier. The kids seemed like they were in a shell but
now even the kids seem happier ... She used to snap at them but
she's a lot calmer. Even with me she used to be snappy. A mother
commenting on changes in her daughter.

And they were able to support others in the community too:

This course opened my mind up. It also gave me a different idea on
how to approach situations ... For example, a couple in a domestic
situation he is blaming her for his reaction, I am able to sit
down ... and get them to think about things, explaining this certain
way is not the only route to take.

3. Maintaining changes in an environment that is resistant to
change

The personal empowerment and change experienced by participants had
lasting impacts on themselves and on those around them; however,
implementing and sustaining change in an environment that is resistant
to change can be fraught with challenges and frustration (Figure 1,
outer circle). A key barrier to change was seen as lack of consistent
and sustainable government support for proven Indigenous developed
programs, coupled with the sheer scale and urgency of work that needed
to be done in order to help others in their communities:

The start stop start is frustrating .... each time funding runs out
we have to wait for another funding. Why can't we get continuing
funding? This is peoples' lives we are talking about. The program
needs to get to children in the school; young adults struggling
to know who they are; town camps where English is second third or
fourth language for people...

Another challenge was peer pressure, as one participant explained:

Friends sometimes get ... offended. It's hard to accept that there
are changes in my life. That would be the most challenging
part-with friends. But they either accept it or they don't that's
when you find out who your true mates are.

In the early stages of the program, many participants told stories
of feeling disempowered: they felt as though they were permanently stuck
in their current situation; they felt overwhelmed by their problems.
However, as participants became more empowered, the stories they told
about themselves often reflected strong values based positive attitudes
and beliefs about life. Such changes are remarkable given the
significant structural barriers many of the participants faced. One
participant shared her vision for the future:

With a lot of our problems amongst the Aboriginal community, we as
a people we have to come together. Not just as people but as
organisations. We need to be working more closely for the betterment
of people. Through that FWB, all other services can be used in a
better way. Then that healing can take place. Organisations need to
come together then families can get on. A lot of those organisations
have different family groups. They've got to stop putting each
other down. All our families have suffering and dysfunction. Not one
is better than another. I know that people are healing through FWB.
It is making changes to individuals but I'm looking bigger. It
needs to come from somewhere else as well.

Those 'bigger' changes that need 'to come from
somewhere else' clearly relate to broader structural forces
constraining individual and group level empowerment and change. This
highlights an urgent need for the current radical policy reform agendas
to better target and maximise the potential of proven existing community
empowerment initiatives.

In summary, the most dominant theme identified from the data as
critically important to the process of empowerment is changes in self.
While not necessarily suggesting a linear progression, changes in self
(Figure 1, inner cycle) appeared to have started with the
participants' clarifying and/or redefining their values and norms
regarding right and wrong behaviour. Creating boundaries and being able
to say 'no' to people was critically important in facilitating
the process. As they went through this process of personal
transformation, participants built up their self-esteem and
self-confidence, and were able to create safer and happier home
environments for themselves and their families.

The personal transformation and empowerment experienced by
participants led to and was in turn reinforced by constructive social
support. As figure 1, the middle circle shows, there were two elements
in constructive social support: (1) support that participants gave and
received from each other, through friendship and social connectedness;
and (2) support that participants gave other members of the community.
Examples of this type of support include more-effective parenting of
their own children; and support for people in distress, such as those
affected by drug and alcohol issues, and those at risk of suicide. The
emphasis on constructive social support is important as it distinguishes
support provided from the vantage point of self awareness of one's
own needs and those of others (hence intended to empower) as opposed to
support that reinforces or creates unhealthy co-dependencies.

The mutually reinforcing processes of personal transformation and
the capacity to give and receive support occurred in the context of both
constraining and enabling factors in the social environment (Figure 1,
outer circle). Some of the constraining factors include peer pressure,
gender inequities, perceived lack of vision and direction among the
Indigenous leadership, and above all inadequate funding from government
to extend the program to the broader community in a timely manner. These
environmental constraints routinely challenged and tested the capacity
of participants to maintain and consolidate the change process.

Discussion

This paper has presented, in some depth, the kinds of changes FWB
participants in Alice Springs were able to make as a result of their
involvement in the program. While every community and program delivery
is unique, the themes discussed here run as a common thread in
post-program interviews across all settings among those who have been
able to engage (for some it was a struggle just to walk in the door) and
experience the program. The stories of change documented in this
research were not from the most marginalized sections of the relevant
Indigenous community and none were experiencing serious drug and alcohol
issues. Most of the participants worked prior to or throughout their
involvement in FWB, despite modest education backgrounds.

However, although these "pioneer" FWB participants did
not necessarily have major alcohol and drug problems themselves, they
were nevertheless seriously affected by other peoples' addictive
behaviours. What FWB did for them was to provide a framework, grounded
in values and principles about respect for self and others' basic
physical, emotional, mental and spiritual needs, to analyse, develop
strength, and supportive networks to take a stand against alcohol and
other abusive behaviour. Many described a new found capacity to set
boundaries to protect their families' physical and social well
being against intrusion by those who had previously created chaos and
stress. On a broader scale, once the more functioning sections of the
community became empowered to stop tolerating abusive behaviour, a
ripple effect occurred as those with abusive behaviour often had no
choice but to start making some changes themselves. This is clearly
evident by the increasing role that FWB is playing in alcohol
rehabilitation and prisoner education in Alice Springs and other
settings across Australia, though this remains to be systematically
evaluated.

These findings are particularly relevant to Pearson's (2001)
notion of denial in addiction as a community rather than individual
responsibility. In terms of the patterns of alcohol use in Indigenous
Australian communities, data from Australian national drug surveys
indicate that while the proportion of Indigenous Australian communities
that consume alcohol is less than in non-Indigenous Australian
communities, a greater proportion of Indigenous Australian drinkers
consume alcohol to harmful levels (Commonwealth Department of Human
Services and Health 1996; Australian Bureau of Statistics 2002). More
specifically, Indigenous Australians are approximately twice as likely
to consume alcohol at a level that increases their risk of harm in the
long-term and approximately 1.5 times as likely to consume alcohol in a
manner that increases their risk of harm in the short-term (Australian
Institute of Health and Welfare 2003). Pearson argues that as a result
of passive welfare and the rise of substance abuse epidemics in
Indigenous communities since the late 1960s, there has been a collapse
of social norms, such as personal responsibility, mutual respect and
family obligations. Today, although the majority of individual community
members may continue to adhere to these values, Pearson has described a
scenario in which many people have become neutral or non judgmental and
hence permissive of the deviant values and behaviours of sub-groups.
Pearson and his colleagues do not see the problem as irreversible and
are seeking to better understand how to address dysfunction and rebuild
positive social norms and social order at community level (Pearson
2007a).

The capacity of FWB participants documented in this paper and
elsewhere (Tsey and Every 2000; Tsey et al 2003; Tsey et al 2005a; Tsey
et al 2005b; Whiteside et al 2006) to take principled stands against
abusive behaviour show the important role that bottom up empowerment
initiatives can play to strengthen and enable the non-addicted
Indigenous majority to be compassionate but firm in their dealing with
the minority's addictions and abusive behaviour. Clearly, in
addition to focusing on those experiencing substance abuse and other
social dysfunction such as making parental responsibility a condition
for receipt of state welfare payments, the radical government reforms
need to support and empower the more functioning elements of the
population to better look after their own needs as well as provide
constructive rather than co-dependent support for others.

Research conducted on the FWB program in other Indigenous
communities and settings around Australia since the program started has
consistently revealed similar findings. Many FWB participants across
Australia identified the FWB principles and values such as respect and
basic human needs with their own traditional knowledge and/or introduced
Christian values and norms. They spoke about their belief that these
values--such as, caring, sharing, reciprocity, respect and trust--hold
the key to rebuilding social norms about what is acceptable and what is
unacceptable behaviour in their communities(Tsey and Every 2000; Tsey et
al 2003; Tsey et al 2005a; Tsey et al 2005b; Whiteside et al 2006). The
importance of values and principles in building healthy relationships
and communities resonate with concepts of "principled
autonomy" identified as the key to understanding and tackling
alcohol and other addictions in modern society (O'Neil, 2002;
Gaughwin 2008). If there is a root cause of addiction in modern society,
according to Gaughwin (2008), it is ethical--linked to freedom and free
will--especially when these values are disconnected or freed from
responsibility and other principles as important checks and balances.
Evidence suggests a lack of appropriate frameworks and tools to engage
in meaningful ethical dialogue with the intended beneficiaries as one of
the key barriers facing the radical government-led interventions in
Alice Springs and other places. Clearly, values-based empowerment
programs such as FWB are potentially valuable tools in facilitating
ethically sound public conversions at community level.

If the Federal and other Government interventions to curb substance
abuse and other social dysfunction in indigenous communities are
examples of building social norms from top down, then programs such as
FWB promotes social norms and principled autonomy from bottom up. The
question here is not a choice between top down versus bottom up. They
require each other in order to achieve sustained impact. For example,
since the interviews for this study were conducted, the Alice Springs
FWB participants, like their counterparts in other FWB sites, have
become valuable network resources for their community, and many are
involved in delivery of the FWB program often under severe funding and
other resource constraints to other members of the community, to men in
prison, to other more vulnerable sections of the community. At present
the resources lie primarily with the government driven interventions and
local initiatives are under-resourced, even though their efficacy has
been demonstrated. FWB networks working at the coal face can benefit
immensely through new funding opportunities under the government
emergency reforms; in return the reforms can benefit from the capacity
of FWB to facilitate values-based conversations on the basis of respect
for self and others.

Empowerment and control are widely accepted as critical elements in
efforts to promote health and wellbeing. But they are also concepts that
over the years have been used loosely by different people to mean
different things. Yet, issues of empowerment and control continue to be
identified as central to improving population health especially for more
vulnerable groups (Wallerstein 2006). The challenge clearly is how to
enact empowerment: it is easy to write about as a concept but at the
sub-revolution level what can policy-makers, service providers and
researchers, for example, do to operationalise empowerment. As figure 1
demonstrates, FWB is about a process that actualises action and change
in an ecological framework from the personal to family and to the wider
community. If as a nation, we are to achieve the necessary indigenous
health and wellbeing targets set by the new Rudd government, it
critically important that we move beyond binary positions and find more
creative ways of harnessing bottom up personal and family level
empowerment and change with macro level structural change. This will
require a bio-psycho-social (Giordano and Wurzman 2008) (and
indeed)-spiritual spectrums of understanding acknowledged as effective
in addressing substance abuse.

References

Australian Bureau of Statistics. 2002.National Aboriginal and
Torres Strait Islander Social Survey. Canberra: Australian Bureau of
Statistics.

Australian Institute of Health and Welfare. 2005. Living
dangerously: Australians with multiple risk factors for cardiovascular
disease. Canberra: Australian Institute of Health and Welfare.

Australian Institute of Health and Welfare.2003. Statistics on drug
use in Australia 2002. Cat. No. PHE 43. Canberra: Australian Institute
of Health and Welfare .

Tsey, K. 2008. The role of customs and beliefs in legitimating
community development in rural Ghana: implications for substance abuse
prevention, Paper presented to the Oxford Round Table 20th Anniversary,
March 9 to March 14. Lincoln College, Oxford University, Oxford, England

Wallerstein, N. 2006. What is the evidence on effectiveness of
empowerment to improve health? WHO Regional Office for Europe, Health
Evidence network report: Copenhagen.
http://www.euro.who.iU/Document/E88086.pdf.

Whiteside, M., Tsey, K., McCalman, J., Cadet-James, Y., and Wilson,
A.2006. Empowerment as a framework for Indigenous workforce development
and organisational change, Australian Social Work, 59(4),.422-434.

Komla Tsey, Associate Professor & NHMRC Principal Research
Fellow, School of Indigenous Australian Studies, School of Public Health
and Tropical Medicine, James Cook University, Cairns Campus, Cairns,
Australia.

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